EDUCATION/RESIDENTS’ PERSPECTIVE Five Strategies to Effectively Use Online Resources in Emergency Medicine

Brent Thoma, MD, MA*; Nikita Joshi, MD; N. Seth Trueger, MD; Teresa M. Chan, MD; Michelle Lin, MD *Corresponding Author. E-mail: [email protected], Twitter: @Brent_Thoma.

0196-0644/$-see front matter Copyright © 2014 by the American College of Emergency Physicians. http://dx.doi.org/10.1016/j.annemergmed.2014.05.029

[Ann Emerg Med. 2014;64:392-395.] may add so much over time that they cannot keep up with the reading list. New users should consider asking trusted colleagues for recommendations or an exported list of the INTRODUCTION Web sites they follow. Additionally, they can look at the list For health professions learners of all levels, staying abreast of of recommended blogs or podcasts that their favorite blogs or the literature can seem like an insurmountable task as the podcasts follow, which can often be found on the home page number of clinically oriented articles continues to grow at an (sometimes referred to as a “blog roll”). increasing rate.1,2 Fortunately, there has been a veritable explosion of online secondary resources that endeavor to digest the expanding medical literature and present it in a format that is STRATEGY 2: USE A PODCAST APPLICATION optimized for adult learners. Particularly in emergency medicine, Downloading, formatting, and organizing podcasts can be these resources have been dubbed “free open access medical time consuming and overwhelming. Podcast applications are to education,” also known as free open access meducation podcasts as RSS readers are to blogs. In both cases, the (FOAM).3 The FOAM movement has figured prominently in user specifies the content, and the software automatically acquires the proliferation of blogs and podcasts made available online by and queues the content for consumption. Podcast applications practicing clinicians.3,4 As an unintended consequence, learners notify users when new podcasts have been released, download must now contend with an exponentially expanding library of them, and play them. There is a variety of free and inexpensive both primary literature and secondary online resources. podcast applications available for all models of smartphones. To make effective use of this stream of knowledge, learners As with RSS readers, users must specify which podcasts they want must filter and choose from myriad resources. Simple digital to download, leading to the same potential problems. Again, a tools can be used to organize and manage this otherwise good place to start is to ask for recommendations from a trusted overwhelming amount of information. This article outlines colleague, as well as recommended sites on blog rolls. 5 strategies to help learners and practicing physicians stay abreast of both foundational and cutting-edge literature by using STRATEGY 3: USE COMPILATIONS TO FIND digital solutions. Table 1 provides an overview of each step. QUALITY RESOURCES The difficulty of identifying good resources has long been STRATEGY 1: USE A REALLY SIMPLE recognized. We have compiled and categorized a list of SYNDICATION READER recommended resources in Table 2. Several innovators have Following FOAM by visiting individual Web sites can be time developed unique solutions to help collate and curate content: consuming and overwhelming. Rich Site Summary, also know as The Life in the Fast Lane Review5 outlines the top FOAM Really Simple Syndication (RSS), feeds allow the latest content content published each week. It is written by an international from specified Web sites to be exported directly to a personalized team of authors that identifies quality resources in 5 categories reader. Rather than going to each site to check for updates, content (emergency medicine, critical care, pediatric emergency is automatically synced when it is published and presented in a medicine, toxicology, and medical education). magazine-like format that is easy to read. There is a variety of free FOAM EM is a blog that simply reposts content from most or inexpensive RSS readers available. A video tutorial demonstrating of the popular FOAM blogs and podcasts. The aggregated how to use Feedly, a popular multiplatform reader, is available content is linked to the original Web site. (Video E1, available online at http://www.annemergmed.com). A recent survey of Canadian residents found that faculty The flexibility of an RSS reader, however, can be a double- recommendations are highly valued by residents selecting edged sword. This strategy works well when an appropriate online resources.6 It may be worthwhile for residency amount of content is added by a user. However, new users can programs to compile internal lists of resources that have have difficulty finding good content, whereas experienced users been vetted by faculty.

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Table 1. Examples and brief descriptions of the 5 strategies to effectively use online resources in emergency medicine. Innovation Examples Description RSS reader Digg Reader, http://digg.com/ An RSS feed reader gathers and automatically delivers articles from Web sites that you Feedly, http://feedly.com/ follow as they are published. This can prevent you from needing to repeatedly visit the G2Reader, http://www.g2reader.com/ same Web sites. Podcast Pocket Cast (Android/iOS, $4) Podcast streaming applications automate the process of downloading and listening to application AntennaPod (Android, free) podcasts by indicating when new podcasts are available for download, downloading Podcasts (iOS, free) them, and playing them. Podcatcher (Windows telephone, $1) Resource LITFL Review, http://lifeinthefastlane.com/ A team of authors at LITFL writes a review article outlining the best new blog posts and compilations blog-news/litfl-review/ podcasts released each week in emergency medicine, critical care, pediatric emergency medicine, toxicology, and medical education. FOAM EM, http://www.foamem.com/ FOAM EM is a blog that reposts content from other popular emergency medicine blogs and podcasts. Social networks Twitter, https://twitter.com/ Most producers of blogs and podcasts have Twitter accounts. With a Twitter account, you can follow and interact with them through brief (140 characters) notes. They send out links to their resources and other helpful information. Facebook, https://www.facebook.com/ Most blogs and podcasts have Facebook pages. With a Facebook account, you can follow their updates, which often include links to their resources, and contact their editors. Googleþ, https://plus.google.com/ Some blogs and podcasts have Googleþ pages and communities. With a Google account, you can follow their updates and participate in detailed discussions. Custom search FOAMSearch, http://foamsearch.net/ FOAMSearch is a custom search engine that searches only specific medical journals, blogs, engine and podcasts, which cuts down the number of irrelevant search results by finding only resources published on Web sites directed at physicians.

LITFL, Life in the Fast Lane.

STRATEGY 4: USE SOCIAL NETWORKS TO Many of the larger blogs and podcasts have Facebook pages CONNECT WITH CONTENT PRODUCERS AND that can be “liked.” Although it is not as easy to engage the PEERS content producers or have detailed discussions on Facebook as it þ With 1-way media (eg, textbooks, e-books, podcasts), some is on Twitter and Google , it is a well-recognized social media learners can feel disconnected from the creators of the resources. platform for personal and professional use. Social networks have revolutionized communication between Social media sites can also be used as an informal feed of producers and consumers of educational content by removing online resources. By following select members of the FOAM traditional barriers. Authors, presenters, innovators, and thought community, users can see what new podcasts or blog posts are leaders are readily available on platforms such as Twitter, available and which garner the most discussion. In comparison to – Googleþ, and Facebook. RSS reader curation, this social media based curation strategy Twitter is a microblogging platform for sharing and receiving trades comprehensiveness for diversity and allows the user to brief (140 characters) pearls and links to recommended selectively choose content that has been implicitly endorsed by content. Most blog and podcast content producers use it to various individuals. publicize, share, and discuss their material. Twitter is also used to extend the reach of conferences7 and local academic teaching STRATEGY 5: USE CUSTOM SEARCH ENGINES TO sessions by reporting lessons learned.8 Recent tweets about FIND RESOURCES WHEN THEY ARE NEEDED FOAM resources can be easily found by searching for the hashtag Finding specific resources quickly when needed can be a #FOAMed. Some organizations and groups are using Twitter to 11 9 challenge. FOAMSearch (formerly GoogleFOAM) is a Google discuss literature through microblogging-based journal clubs. custom search engine that searches only specific sites that are relevant Pearls from the weekly didactic sessions incorporated into most to emergency medicine and critical care clinicians. By focusing on emergency medicine residency programs are tweeted out with the both medical journals and reputable FOAM resources (including hashtag #EMConf. A video tutorial demonstrating how to follow blogs, podcasts, decision support Web sites, and medical other users, tweet, and use hashtags is available (Video E2, calculators), it is easier to find specific, helpful resources. available online at http://www.annemergmed.com). Googleþ is better suited to detailed discussions because there are no space limitations. Like Twitter, it is possible to follow the FUTURE DIRECTIONS producers of online content, and some independent Web sites Medical education, particularly within emergency medicine, have companion Googleþ pages. Googleþ also allows users to is rapidly embracing online educational resources. In fact, establish communities to foster discussion on particular niches the Accreditation Council for Graduate Medical Education such as critical care.10 Residency Review Committee now permits residency programs

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Table 2. Recommended emergency medicine blogs, podcasts, content and the successes of peer review in FOAM,13 verifying and Web sites. reliability remains elusive. There are increasing efforts to adapt 13,14 Resource Type URL and implement peer review for online educational resources Basic emergency medicine resources and, in the future, quality indicators may be developed to assist BoringEM Blog http://boringem.org/ with the evaluation of these resources. However, as with other EM Basic Podcast http://embasic.org/ secondary scholarly resources, online content needs to be Flipped EM Classroom Video podcast http://flippedemclassroom. considered and discussed critically.15 wordpress.com/ Despite the tools discussed in this article, curation remains a Critical care resources EMCrit Podcast http://emcrit.org/ constant challenge. Developing archival systems for diverse Pulm CCM Blog http://pulmccm.org/ groups of digital resources and enhancing custom search engines 16 The RAGE Podcast Podcast http://ragepodcast.com/ will enhance their usefulness. The Social Media Index is a tool Resus.Me Blog http://resus.me/ that attempts to quantify impact for these resources in a way that EMS/retrieval medicine is similar to journal impact factors for scientific journals: it uses PHARM Blog/podcast http://prehospitalmed.com/ fi Rural Flying Doctor Blog http://ruralflyingdoc.com/ objective metrics of distribution, including Web site traf c, to Evidence-based medicine create a ranked list of the most widely accessed emergency Best Bets Web site http://bestbets.org/ medicine and critical care content and, with further validation, EM Literature of Note Blog http://emlitofnote.com/ may serve as a helpful directory of resources. iClickEM is a search EM Nerd Blog http://emnerd.com/ engine currently in beta testing. Rather than using a Google The NNT Web site http://thennt.com/ fi SMART EM Podcast http://smartem.org/ search engine to search speci ed resources on the Internet (such General emergency medicine resources as FOAMSearch), iClickEM uses customized algorithms to Academic Life in Blog http://academiclifeinem.com search the entire Internet and return the highest-yield resources Emergency Medicine for emergency physicians. Natural language search17 (search that EM Cases Podcast http://emergencymedicine uses naturally spoken language or questions rather than key cases.com/ fi Emergency Medicine Blog/video http://emergencymedicine words) may also help physicians to nd what they are looking for, Ireland podcast ireland.com/ especially when combined with a search engine that can make use ER Cast Podcast http://ercast.org/ of medical terminology and physician-specific algorithms. Life in the Fast Lane Blog http://lifeinthefastlane.com/ Finally, although there has been an explosion of the number of REBEL EM Blog http://rebelem.com/ these educational resources,4 they receive minimal academic St. Emlyn’s Blog http://stemlynsblog.org/ 18,19 ’ recognition. This may inhibit the involvement of academic The Skeptic s Guide Podcast http://thesgem.com/ fi to EM physicians and slow the advancement of the eld. Measures must Interpretive resources be taken to acknowledge these forms of scholarly expression on par Amal Mattu’s Emergency Video podcast http://ekgumem.tumblr.com/ with similar techniques for dissemination, such as national lectures, ECG of the Week review publications, and textbook chapters. After all, a podcast is Dr. Smith’s EKG Blog Blog http://hqmeded-ecg.blogspot. com/ simply a permanent lecture that can be shared with a much wider Sonospot Blog http://sonospot.com/ audience. For these works to be rewarded as scholarly activities, Ultrasound Podcast Video podcast http://ultrasoundpodcast.com/ reporting standards for impact will need to be created. Pediatric emergency medicine Don’t Forget the Bubbles Blog http://dontforgetthebubbles. com/ CONCLUSION Pediatric EM Morsels Blog http://pedemmorsels.com/ The world of online educational resources in medicine is PEM ED Podcast http://pemed.org/ EM PEM Podcast http://empem.org/ growing quickly. Tools such as RSS readers, podcast applications, Toxicology resources curated lists of current blog or podcast content, social networks, The Poison Review Blog http://thepoisonreview.com/ and custom search engines have been developed that can assist Tox Talk Podcast http://toxtalk.org/ learners to navigate the flood of information. Educators and Trauma learners should consider adopting these tools to customize their Trauma Professional’s Blog http://regionstraumapro.com/ Blog online medical education and personal learning network.

Supervising editors: Cindy H. Hsu, MD, PhD; Debra E. Houry, MD, MPH “ to replace up to 20% of didactic lectures with individualized fi ”12 Author af liations: From the Learning Laboratory and Division interactive instruction that may include these resources. of Medical Simulation, Department of Emergency Medicine, However, there is substantial room for continued growth in terms Massachusetts General Hospital, Boston, MA, and Emergency of quality, responsible use, curation, and academic recognition. Medicine, University of Saskatchewan, Saskatoon, SK, Canada Quality remains a primary concern with online content (Thoma); the MedEdLIFE Research Collaborative, San Francisco, because of its lack of peer review or other mechanisms to ensure CA (Thoma, Joshi, Chan, Lin); the Division of Emergency Medicine, accuracy. Despite the many examples of high-quality online Department of Surgery, Stanford University, Palo Alto, CA (Joshi);

394 Annals of Emergency Medicine Volume 64, no. 4 : October 2014 Thoma et al Strategies to Use Online Resources in Emergency Medicine the Department of Emergency Medicine, George Washington 7. Neill A, Cronin JJ, Brannigan D, et al. The impact of social media on a University, Washington, DC (Trueger); the Division of Emergency major international emergency medicine conference. Emerg Med J. Medicine, Department of Medicine, McMaster University, Hamilton, 2013;1-4. ON, Canada (Chan); and the Department of Emergency Medicine, 8. Lin M. Residency programs on Twitter. Acad Life Emerg Med;2014. University of California, San Francisco, CA (Lin). Available at: http://academiclifeinem.com/em-im-residency-on- twitter/. Accessed March 15, 2014. Funding and support: By Annals policy, all authors are required to 9. Thangasamy IA, Leveridge M, Davies BJ, et al. International Urology disclose any and all commercial, financial, and other relationships Journal Club via Twitter: 12-month experience. Eur Urol. 2014;66: in any way related to the subject of this article as per ICMJE conflict 112-117. of interest guidelines (see www.icmje.org). The authors have stated 10. Nickson CP, Greenwood J, Le Cong M, et al. FOAM critical care community. Google Plus. 2014. Available at: https://plus.google.com/ that no such relationships exist and provided the following details: communities/108570392322669871916. Accessed March 15, 2014. Dr. Trueger receives a stipend for his work as the social media 11. Raine T. FOAM search. 2014. Available at: http://googlefoam.com/. editor (Twitter) for Emergency Physicians Monthly. Accessed March 15, 2014. 12. Reiter DA, Lakoff DJ, Trueger NS, et al. Individual interactive instruction: an innovative enhancement to resident education. Ann REFERENCES Emerg Med. 2013;61:110-113. 1. Priem J. MEDLINE literature growth chart. jasonpriem.org.2010. 13. Thoma B, Chan TM, Desouza N, et al. Implementing peer review at an Available at: http://jasonpriem.org/2010/10/medline-literature- emergency medicine blog: bridging the gap between educators and growth-chart/. Accessed March 15, 2014. clinical experts. CJEM. 2014;16:1-4. 2. Larsen PO, von Ins M. The rate of growth in scientific publication and 14. Reynolds RJ, Candler CS. MedEdPORTAL: educational scholarship for the decline in coverage provided by Science Citation Index. teaching. J Contin Educ Health Prof. 2008;28:91-94. Scientometrics. 2010;84:575-603. 15. Glassick CE. Boyer’s expanded definitions of scholarship, the 3. Nickson CP, Cadogan MD. Free open access medical education standards for assessing scholarship, and the elusiveness of the (FOAM) for the emergency physician. Emerg Med Australas.2014; scholarship of teaching. Acad Med. 2000;75:877-880. 26:76-83. 16. Thoma B. Social media index. Acad Life Emerg Med; 2013. Available 4. Cadogan M, Thoma B, Chan TM, et al. Free open access meducation at: http://academiclifeinem.com/social-media-index. Accessed March (FOAM): the rise of emergency medicine and critical care blogs and 15, 2014. podcasts (2002-2013). Emerg Med J.2014.http://dx.doi.org/10. 17. Wu W. Proactive natural language search engine: tapping into structured 1136/emermed-2013-203502. data on the Web. In: Proceedings of the 16th International Conference 5. Guthrie K, Davis T, Thoma B, et al. LITFL Review. Life in the Fast Lane. on Extending Database Technology; Genoa, Italy, March 18-22, 2013. 2014. Available at: http://lifeinthefastlane.com/blog-news/litfl- 18. Anderson MG, Alessandro DD, Quelle D, et al. Recognizing diverse review/. Accessed March 15, 2014. forms of scholarship in the modern medical college. Int J Med Educ. 6. Purdy E, Thoma B, Bednarczyk J, et al. The use of free online 2013;120-125. educational resources by Canadian emergency medicine residents and 19. ProfHacker. The challenges of digital scholarship. Chron High Educ. program directors. CJEM.2014. 2012.

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